Systemic Artery to Pulmonary Artery Shunt Mimicking Acute Pulmonary Embolism, Unmasked by a Multimodality Imaging Approach

In this report, we describe the functional imaging findings of systemic artery to pulmonary artery shunt in V/Q SPECT CT imaging. A 63-year-old man with small-cell lung cancer underwent CT pulmonary angiography (CTPA) for suspected acute pulmonary embolism (PE). The CTPA showed an isolated segmental filling defect in the right lower lobe, which was initially interpreted as positive for PE but was actually the consequence of a systemic artery to pulmonary artery shunt due to the recruitment of the bronchial arterial network by the adjacent tumor. A V/Q SPECT/CT scan was also performed, demonstrating a matched perfusion/ventilation defect in the right lower lobe.

Giant bilateral axillary artery aneurysms with left complete obstructive thrombus in intravenous immunoglobulin-sensitive Kawasaki disease: a case report

Background Kawasaki disease (KD) is a systemic vasculitis that predominantly affects medium-sized arteries. In addition to well-known coronary artery aneurysms (CAAs), peripheral systemic artery aneurysms (SAAs) have also been sporadically reported. In the literatures, SAAs occurred mainly in untreated, intravenous immunoglobin (IVIG)-resistant, or severe refractory KD, and thrombotic events in SAAs were rarely reported. Case presentation A 10-month-old boy with a history of KD was referred to our hospital for suspected pseudoaneurysm of the axillary arteries. Four months prior to presentation, he had persistent fever, conjunctival congestion, and rash. On the 10th day of fever echocardiogram showed biliteral CAAs. He was then diagnosed with KD and given IVIG 2 g/kg and aspirin at a local hospital. His fever and symptoms soon subsided and he was discharged with low dose aspirin and dipyridamole. One month prior to presentation, his parents incidentally palpated swellings in his bilateral axillae. On admission, physical examination revealed a pulsatile swelling in his right axilla and a non-pulsatile swelling in the left with impalpable left brachial and radial pulses, cooler and less active left upper limb than the right one. While the pulses of other three limbs were normal. Ultrasound examination revealed giant bilateral axillary artery aneurysms (AAAs) with massive thrombus in the left. Angiography confirmed giant bilateral AAAs with left AAAs completely occluded and fine collateral vessels connecting to the distal brachial artery, in addition to giant bilateral multiple CAAs without stenoses. The patient was given intravenous prostaglandin for 10 days to allow for formation of collateral circulation, as well as aspirin, low molecular weight heparin (which was switched to warfarin before discharge) and metoprolol. At discharge, the temperature and movement of his left upper limb improved significantly. On follow-up at 7 months, his left upper limb further improved and was similar to the right with no occurrence of cardiovascular events. The images of CAAs and AAAs on echocardiogram and computerized tomography remained the same. Conclusions This case highlights the importance of evaluating peripheral SAAs in KD patients with CAAs, even if their course of treatment appears smooth. For both large non-aortic SAAs and CAAs in KD patients, antithrombotic therapy is of utmost importance.

Transcatheter Embolization of Systemic-to-pulmonary Artery Fistulas: a Case Report

The systemic artery to pulmonary vessel fistula(SAPVF) is an uncommon vascular abnormal communication between systemic arteries (except bronchial arteries) and the lung parenchyma[1]. It can be divided into congenital and acquired causes. Congenital SAPVF is often accompanied by cardiac or pulmonary artery hypoplasia, and acquired are usually caused by pleural adhesions after pleurisy, empyema, trauma, or surgery[2].We report a case of transcatheter arterial embolization for the treatment of congenital right inferior phrenic artery to pulmonary artery fistula.

Massive Hemoptysis Treated with Embolization Of an Ectopic Bronchial Artery Arising from the Right Thyrocervical Trunk: A Case Report

Background: Ectopic bronchial artery and non-bronchial systemic arteries may be the culprit vessels of hemoptysis. The main cause of clinical failure of bronchial artery embolization is incomplete embolization caused by the misidentification of the culprit arteries by conventional angiography. Multidetector computed tomography angiography is useful for visualizing the culprit arteries. Case presentation: An 82-year-old man was admitted with hemoptysis. Preprocedural multidetector computed tomography angiography revealed an ectopic bronchial artery branching from the right thyrocervical trunk. Superselective embolization of the ectopic bronchial artery was performed using gelatin sponge particles and metallic coils. Hemoptysis was controlled by this procedure without any associated complications. Conclusions: Ectopic bronchial arteries originating from the thyrocervical trunk are rare. Preprocedural multidetector computed tomography angiography is useful for visualizing the culprit arteries of hemoptysis, especially if a patient has an ectopic bronchial artery or an ectopic non-bronchial systemic artery.

Three-dimensional CT Angiography Facilitates Uniportal Thoracoscopic Anatomic Lung Resection for Pulmonary Sequestration

BackgroundPulmonary sequestration (PS) is a rare lesion with independent blood supply from an anomalous systemic artery. A timely resection is considered the best treatment for PS, but the optimal approach is controversial. Three-dimensional computed tomography angiography (3D-CTA) has been widely utilized for precise thoracic surgery. This study aimed to investigate the safety of uniportal video-assisted thoracoscopic surgery (VATS) for PS assisted with preoperative 3D-CTA. MethodsThe data of patents with PS who underwent VATS anatomic lung resection between April 2011 and May 2021 in a single centre were retrospectively reviewed. They were divided into uniportal and tow-port groups according to the initial surgical plan. The perioperative parameters including the incidence of conversion to open thoracotomy, operation time, blood loss, complications and chest tube duration were analyzed. ResultsTwenty consecutive patients (9 in uniportal group and 11 in two-port group) underwent VATS for PS, including 12 female and 8 male patients, with a mean age of 45 years old (range, 24-60 years). Nine cases demonstrated recurrent febrile, cough, or hemoptysis; whereas the other 11 patients were asymptomatic. The 3D-CTA was utilized for all patients in the uniportal group and 1 patient in the two-port group. Eighteen (90.0%) intralobar and 2 extralobar PS were confirmed; and 18 (90.0%) lesions were located in the left thorax. The feeding vessels originated from the thoracic aorta in 16 patients (80.0%), the abdominal aorta in 3 (15.0%) and the inferior phrenic artery in 1 patient (5.0%). Thirteen lobectomies, 5 segmentectomies and 2 mass excisions were performed. There was no major bleeding or 30-day mortality. No conversion was needed in the uniportal group; whereas 6 (54.5%) conversions (4 to multiple-port and 2 to thoracotomy) occurred in the two-port group, indicating a significant difference (P=0.008). In addition, the operation time in the uniportal VATS group was significantly shorter than those in the two-port VATS group ([110.6 ± 25.5] min vs. [148.6 ± 42.1] min, P = 0.029). The other perioperative variables were similar between the two groups. During the follow-up of 5-75 months, no recurrence of hemoptysis was recorded. ConclusionPreoperative 3D-CTA facilitates the safe performance of uniportal VATS anatomic lung resection for PS, which might be associated with shorter operation time and lower conversion to thoracotomy.

Carotid Artery Elasticity Variables as Predictors for the Risk of Coronary Arterial Lesions in Patients With Coronary Artery Disease

Background: Carotid artery can be considered as the window to reflect systemic artery atherosclerosis. Nowadays, the evaluation of carotid artery lesions both from the structural and functional aspects in patients with coronary artery disease (CAD) by ultrasonographic imaging is one of the preferable tools. Materials and Methods: Patients with suspected CAD underwent coronary angiography and were assigned to one of four groups (non-CALs, atherosclerosis, single-lesion and multi-lesion) based on the results. Carotid artery intima-media thickness (IMT) and arterial stiffness were investigated by quality intima-media thickness (QIMT) and quality arterial stiffness (QAS) techniques. Univariable and multivariable modeling were used to investigate arterial elasticity predictors of CALs. Area under the receive operating characteristic curve (AUC) was used to evaluate diagnostic accuracy.Results: Carotid IMT and stiffness variables pulse wave velocity (PWV), α, β and compliance coefficient (CC) were statistically different between every two-group comparisons. Multivariable logistic regression analyses demonstrated that the odd ratio (OR) for patients with CALs were 1.73, 1.67, 1.19, 1.23 and 0.56 accordingly as IMT, PWV, α, β and CC were concerned. The OR values were similar with or without. The AUC of IMT, PWV, α, β and CC were 0.9257, 0.8910, 0.8016, 0.9383, 0.8581 with correctly classified rate of 88.16%, 83.77%, 78.07%, 86.84%, and 81.58%, respectively. Conclusions: The ultrasnongraphic variables derived from QIMT and QAS analysis present favorable diagnostic values for patients with CALs. The vascular stiffness changes predicted by QAS variables highlighted the hypothesis that functional impairment might predate structural damages as we can detect.

Debating the embolization of a large aberrant systemic artery for pulmonary sequestration using an Amplatzer duct occluder: a case report and literature review

Here, we report two rare cases of pulmonary sequestration that were fed by large systemic arteries and embolized with a large Amplatzer duct occluder and their 3-year follow-up, and we discuss the efficacy and safety of the embolization of a large aberrant systemic artery to pulmonary sequestration using an Amplatzer duct occluder. A 9-year-old boy complained of chest pain for 1 month, and a 6-year-old boy initially complained of recurrent cough for 3 months. A series of examinations was launched to evaluate any possible malformation or abnormalities in the patients. Chest CT and CTA identified a right lower pulmonary sequestration with infection. After admission, transcatheter device occlusion was planned after essential antibiotic treatment, and postoperative infection prevention and anti-inflammatory treatment were given. In the following 2 years of follow-up, neither of the children had recurrent chest pain, cough or other related symptoms. However, the CT follow-up demonstrated that a residual mass was visible in both patients. The same chest scan section revealed slight reductions in lung lesions from 38.344 cm2 to 37.119 cm2 (3% reduction) and 14.243 cm2 to 13.178 cm2 (7.5% reduction) for each patient. No follow-up data demonstrated the long-term clinical outcomes of the residual lesion. We do not recommend that embolization be performed for large pulmonary sequestration lesions with an aberrant artery larger than 6 mm that is planned to receive a device larger than 10 mm, as their outcomes showed a higher possibility of rebuilding the vascularization network feeding the pulmonary sequestration, indicating a higher risk for long-term complications.